OTC Supplement Use Common For Symptom Management in Rheumatic Diseases
Pain, fatigue, and sleep disturbances are common symptoms with rheumatic diseases.
The use of OTC supplements—including vitamins, sleep aids, and pain relievers—is a common method of symptom management in patients with rheumatic and musculoskeletal diseases, according to research results published in Rheumatology Advances in Practice.1
Pain, fatigue, and sleep disturbances are common symptoms with rheumatic diseases. | Image credit: TomAI - stock.adobe.com
The pain, fatigue, and sleep disturbances common in patients with rheumatic and musculoskeletal diseases may lead to patients utilizing OTC supplements to self-manage these symptoms of their disease. Not only does this use create a potential financial burden, but the use of OTC products is also frequently poorly documented in electronic health records.
A group of researchers in the United Kingdom therefore conducted a survey study evaluating the prevalence of use of OTC products, including supplements, sleep aids, and pain relievers in patients with rheumatological conditions. The survey was administered to patients in the rheumatology department at Salford Royal Hospital in the England between October 2022 and March 2024.
A total of 785 patients completed the survey. Within this cohort, 91.2% of respondents reported the use of at least 1 supplement, pain reliever, or sleep aid, with 7% indicating that they used all 3 types of OTC products.
A total of 710 respondents completed questions on OTC supplement use (73% women; mean age, 58±14.5 years; 94.3% white). The most common musculoskeletal conditions included osteoarthritis, rheumatoid arthritis (32% each), and fibromyalgia (24%). Sixty-four percent and 31% of respondents indicated having 1 or more, or 2 or more, long-term health conditions.
A majority of patients (54.5%) took 1 or more supplements daily; 37.3% reported taking 2 or more supplements daily (median number of supplements, 2; interquartile range [IQR], 1-4). The most commonly used supplements included vitamin D (66%), multivitamins (32%), vitamin C (22%), vitamin B (19.4%), calcium (18.4%), omega-3/omega-6 (18.1%), turmeric (16.4%), magnesium (16.1%), zinc (11.1%), and glucosamine (9.8%).
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Among this group, there was a “large overlap” between different supplements. Several respondents took a multivitamin plus vitamin D (16.2%), omega-3/omega-6 (3.7%), calcium (3.4%), vitamin B (4.9%), or vitamin C (4.9%). Large overlaps were also noted between vitamins D and C, vitamin D and calcium, vitamin D and a multivitamin, and vitamins D and B.
A total of 82% of respondents completed questions on sleep aid use (73% women, mean age, 58.3±14.3 years). The most common diagnoses in this group were osteoarthritis (38.9%) and fibromyalgia (35.1%); 37% of these respondents also indicated having anxiety and depression.
Thirty-two percent of patients reported using prescription sleep aids, while 25.2% reported using nonprescription sleep aids, 14.2% reported using OTC sleep aids, and 4.2% reported using sleep aids from a combination of sources. Nineteen percent reported using a prescription antihistamine, such as diphenhydramine (Benadryl) and 51% reported using cannabidiol (CBD) oil.
Among respondents, 88% completed survey questions around pain reliever use. Among individuals who reported experiencing pain in the last week, 82% used some form of pain reliever—either a prescription or nonprescription drug such as acetaminophen, an nonsteroidal anti-inflammatory drug (NSAID), or an opioid.
Among respondents who used nonopioid pain relievers, 73% reported using acetaminophen, 51.1% used a nonsteroidal anti-inflammatory drug, 29% used ibuprofen, 13% used naproxen, and 4.6% used diclofenac. A total of 20.5% of respondents reported using OTC ibuprofen, with 3.9% and 2.2% receiving it from nonprescription and prescription sources, respectively; 3.3%, 0.8%, and 0.6% of diclofenac users received it via prescription, non-prescription sources, and OTC, respectively.
Overlap between NSAIDs and supplements was also common, with 50.5% of respondents who took NSAIDs also taking supplements. In the ibuprofen group, 37.6% also took vitamin D, 13.9% took vitamin B, 17.7% took multivitamins, and 11.2% took turmeric.
A total of 20.5% of respondents took opioids medications to manage their pain, 12.5% of whom took codeine and 6.7% of whom took codeine/acetaminophen, followed by tramadol (3.9%). Within this group, 50.3% also reported taking supplements, 47% reported also taking vitamin and mineral supplements, and 12% reported also taking herbal or food supplements.
Median total cost of supplement use was £15 per month (IQR, £6-£30; US $19.03, IQR, $7.61-$38.07), with a mean value of £24.80 (US $31.47) per month. The median cost of OTC medications, sleep aids, CBD products, and supplements, excluding pain relief medications that were prescribed, was £10 month (IQR, £5-£20; US 12.69, IQR, $6.34-$25.38), with a mean value of £19.53 per month (US $24.79); costs for these products ranged from £1 per month to £200 per month (US $1.26 to $253.94).
After adjusting for age and sex, results of a logistic regression model did not identify any factors significantly associated with the use of OTC supplements. By condition, patients with axial spondyloarthritis and fibromyalgia had a higher odds ratio of using sleep aids vs those without (OR, 2.32; 95% CI, 1.13-4.52 and OR, 1.81; 95% CI, 1.10-2.97, respectively), and individuals with rheumatoid arthritis, osteoarthritis, and fibromyalgia had higher odds of using medications for pain relief vs those without (aOR, 1.58, 95% CI, 1.04-2.44); aOR, 3.34, 95% CI, 2.03-5.75); and aOR 3.44, 95% CI, 1.95-6.48, respectively).
Study limitations include the use of an electronic survey, which may have excluded people with low digital literacy and the absence of a sampling strategy.
“There is a high prevalence of OTC supplement and nonprescription analgesic use in patients with [rheumatic and musculoskeletal diseases,” the researchers concluded. “As patients rely increasingly on such self-management strategies and access health information from a variety of sources online, it is especially important, from a drug safety perspective, for health care professionals to proactively ask about such strategies in their consultations,” particularly in light of concerns about drug-drug interactions between prescribed medications and OTC supplements, the quality of which is largely unregulated.
Future studies should focus on comparisons of OTC supplement use with health controls in order to evaluate how supplement use differs from this patient population.
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